INTAKE NAVIGATOR II

JOB PURPOSE: The Intake Navigator will directly educate a prospective participant through the onboarding process leading to enrollment in CenterLight's Program of All-inclusive Care for the Elderly (PACE). This person will work closely with referral sources, account managers, clinical intake, and provider relations to ensure all and tasks are efficiently completed associated with the enrollment process. The Intake Navigator is expected to maintain ethical conduct, compliance with state, federal and PACE regulatory requirements, and will be responsible for quality and satisfaction of prospective participants, caregivers, and referral sources. JOB RESPONSIBILITIES : Correspond directly with the prospective participants to provide plan education and qualification screening. Respond to all incoming/outgoing calls, data entry, emails, schedule assessments and mail information to prospective participant. Meet the departmental productivity goals as specified by management for the growth of the company. Become an expert about CenterLight PACE program eligibility requirements, services, and benefits. Address eligibility issues, application processing and referrals to Maximus to resolve potential participant issues. Work closely with all departments to onboard and retain participants. Obtain referral details to assess and determine appropriate next steps for expeditious enrollment processing. Evaluate factors unique to each referral including, but not limited to their clinical condition, financial situation, their entitlements status and home support systems. Use knowledge obtained through the qualification screening to determine which government agencies and team members (entitlements specialists, assessment nurses, etc.) should be assigned to the prospect or caregiver in the next step of enrollment. Verify plan and entitlement status utilizing LDSS/HRA/CMS resources and functions. Perform provider network verification and other validation of provider participation. Enter calls/inquiries into central database for tracking and follow-up and schedule appointments with the prospect/caregiver. Monitor and report Intake team performance measures to improve delivery and execution of onboarding procedures (CDPAS enrollment, acquisition of entitlements, logistical delivery of service plans, request for provider network recruitment, etc.). Maintain and generate reports to measure performance and quality of work as set forth by CenterLight. Participate in implementing workflows and Standard Operating Procedures. Advise on the development of tools and process improvements to increase quality and departmental operational efficiencies. Collect and review completeness of all required documents for processing enrollment transactions and reconciliation of enrollment files. Provide training and process orientations to Business Development team members and other business functions as needed. Maintain knowledge of all applicable CMS, DOH, and PACE-specific guidelines, including organizational and departmental policies and procedures. Maintain compliance with Medicaid, Medicare, and PACE regulations. All other duties as assigned or requested. Weekly Hours: 40 Schedule: 8:30 AM - 5:30 PM QUALIFICATIONS: Education: HS Diploma required. Associate Degree, preferred. Experience: Minimum 2 years work experience in healthcare; preferably with MLTC, MAP, or PACE programs and/or homecare; primarily in intake/enrollment functions. Knowledge of Medicaid, Medicare and PACE regulations for eligibility and enrollment. Proficiency with CRM platforms; knowledge of Care Compass strongly preferred. Knowledge of Maximus, eMedNY, ePACES, CMS MARx and other related HRA/CMS resources and functions, preferred. Proficiency in Microsoft Excel, Word. Outlook and Teams. Excellent interpersonal skills, along with demonstrated ability to handle situations requiring immediate and urgent attention, while meeting targets and projections and performing daily tasks. Highly organized and flexible to meet submission deadlines. Experience in working independently without significant oversight and or direction from a supervisor. Comprehensive understanding of federal and state regulatory requirements with respect to health care eligibility, coverage, and services of various public programs a plus. Familiarity with healthcare organizations and general population dynamics within the greater New York Metropolitan region a plus. Other: Excellent written and oral communication skills a must, familiar with medical technology preferred. Written and verbal fluency in a secondary language strongly preferred. Proficiency in Microsoft office products. Knowledge of PACE program benefits and services preferred. Positive attitude and outlook with the ability to multi-task in a constantly changing environment. Knowledge of community-based long-term care services to dual eligible and frail adult population. Highly organized and flexible to meet submission deadlines. Experience in working independently without significant oversight and or direction from a supervisor. Weekdays, nights, and weekends may apply. Physical Requirements Individuals must be able to sustain certain physical requirements essential to the job. This includes, but is not limited to: Standing - Duration of up to 6 hours a day. Sitting/Stationary positions - Sedentary position in duration of up to 6-8 hours a day for consecutive hours/periods. Lifting/Push/Pull - Up to 50 pounds of equipment, baggage, supplies, and other items used in the scope of the job using OSHA guidelines, etc. Bending/Squatting - Have to be able to safely bend or squat to perform the essential functions under the scope of the job. Stairs/Steps/Walking/Climbing - Must be able to safely maneuver stairs, climb up/down, and walk to access work areas. Agility/Fine Motor Skills - Must demonstrate agility and fine motor skills to operate and activate equipment, devices, instruments, and tools to complete essential job functions (ie. typing, use of supplies, equipment, etc.) Sight/Visual Requirements - Must be able to visually read documentation, papers, orders, signs, etc., and type/write documentation, etc. with accuracy. Audio Hearing and Motor Skills (language) Requirements - Must be able to listen attentively and document information from patients, community members, co-workers, clients, providers, etc., and intake information through audio processing with accuracy. In addition, they must be able to speak comfortably and clearly with language motor skills for customers to understand the individual. Cognitive Ability - Must be able to demonstrate good decision-making, reasonableness, cognitive ability, rational processing, and analysis to satisfy essential functions of the job. Disclaimer: Responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the needs of the company. We are an affirmative action and equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity, national origin, veteran status, height, weight, or genetic information. We are committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. Salary Range (Min-Max): $61,000.00 - $71,000.00

Created: 2024-11-02